Program Integrity

Stop improper payments with a holistic, identity-driven approach to program integrity and fraud investigation.

A Question of Program Integrity: Moving Away from the Pay and Chase Model by Leveraging Identity Analytics

For government agencies, program integrity ensures compliance, efficiency, and accountability within programs by detecting and preventing fraud, waste, and program abuse. Government agencies have done the right thing by making critical health and human services benefits and other government services accessible to children, families and other individuals who need them. However, agencies face the difficult task of properly screening and enrolling beneficiaries and recipients within these programs.

With Program Integrity Solutions from LexisNexis®, government agencies are now able to greatly reduce the dollars spent on improper payments from intentional fraud and unintentional errors, while still meeting stringent timelines and delivering needed benefits, without slowing down the process. Every dollar saved through effective fraud prevention is another dollar that goes to the people who need help.

In a survey on the benefits of combating fraud, abuse and improper payments, enabling personnel to address potential fraud indicators ahead of payments ranked as the highest priority for 60% of respondents. Adopting a strategy that emphasizes early detection of fraud prevents overpayments by identifying claims made by citizens who use false identities. Failure to detect fraud immediately can result in a chain reaction of costly improper payments and time wasted on deceitful, non-qualified beneficiaries.

Running agency data through the LexisNexis identity-based fraud analytics solutions is a proactive way to prevent, detect and investigate fraud, giving your agency the ability to:

  • Maintain a clean, current list of beneficiaries or recipients
  • Perform a complete data analysis with results that reveal fraud rings
  • Understand complex relationships between providers and beneficiaries that are indicative of fraud
  • Identify wealth indicators and unclaimed assets that frequently suggest fraud
  • Reveal family and household composition changes
  • Anticipate potential fraud using predictive identity analytics to reveal patterns at change of service intervals
  • Prioritize investigations based on pre-set criteria
  • With the help of LexisNexis in authenticating and verifying identities, Florida DCF was recently named by Florida Governor Rick Scott as a “Governor’s Savings Award” recipient.

  • LexisNexis leverages its analytics and advanced linking technology to then filter and link that information, based on relevance, to an entity, individual or business.

  • Florida Department of Children and Families saved taxpayers more than $12 million by utilizing LexisNexis® Identity Analytics.

Program Integrity Solutions from LexisNexis® are front-loaded with access to 37 billion records linked from more than 10,000 data sources to make locating, identifying, proofing and authenticating individuals a simple and reliable process. By cross-referencing and matching layers of disparate data, our identity analytics and identity management tools identify a variety of data anomalies and proactively detect fraudulent claim attempts.

Program Integrity Solutions that Integrate into your Agency's Workflow

One of the keys to getting the most out of a program integrity solution is to understand the current programs, policies and workflows, and seamlessly integrate the tools that best support your agency’s business process. LexisNexis representatives are experts at looking at agency policies and workflows to develop
customized solutions.

Front-end Identity Fraud Protection

Confirm the identities of users accessing your programs by accessing the LexisNexis knowledge-based, multifactor authentication systems. Identity Management Solutions from LexisNexis such as LexisNexis® Instant Verify and LexisNexis® Instant Authenticate answer the question “Does this identity exist?” and “Are you the owner of this identity?” Installing these solutions in front of the application process, during regular re-certification efforts and around high-risk transactions significantly curtails identity-driven fraud.

Eligibility Verification Tools that are Fair Credit Reporting
Act (FCRA) Compliant

Based on Federal law, the FCRA applies to “determination of the consumer’s eligibility for a license or other benefit granted by a governmental instrumentality” and includes benefits such as the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and Medicaid. LexisNexis® Program Integrity Solution suite has an FCRA compliant offering that provides critical information to support fast, accurate eligibility verification. The LexisNexis® Benefit Assessment offering:

  • Provides identity elements such as name, current address, and phone number
  • Provides information necessary to support an eligibility determination, such as family composition and criminal history details
  • Provides a more complete picture of an applicant's wealth and assets
  • Enables consumers to dispute information included in the consumer report provided by LexisNexis
  • Helps reduce manual processes for greater efficiency and expedited delivery of benefits

Fraud Monitoring and Investigation Tools

Detect and investigate fraud with LexisNexis® Benefit Integrity Scan. Benefit Integrity Scan empowers government agencies to:

  • Review 100% of the individuals currently receiving benefits across multiple programs at once, via an
    automated process
  • Identify individuals with significant risk indicators
  • Prioritize and segment and fraud investigations based on detailed data elements indicators flagged on the list of potential fraudsters
  • Reduce investigation times from days or weeks to minutes
  • Minimize the benefits wrongfully given to unqualified applicants, thereby increasing the benefits available to qualified applicants

Address Modern Challenges with an Identity Hub or Contributory Database

Reduce fraud by identifying individuals who are participating in the same program multiple times within and across state lines with an Identity Hub or Contributory Solution provided by LexisNexis. These systems can focus on one type of program such as SNAP or they can expand coverage across multiple government programs such as Medicaid, Unemployment Insurance, and TANF.

Fraud prevention is just the beginning. Along with reducing fraud and ensuring the right people are receiving benefits, the Contributory Solution also helps agencies to:

  • Boost productivity by streamlining and automating investigations
  • Reduce errors and delays associated with manual processes
  • Reallocate internal resources
  • Satisfy audit and compliance regulations
  • Improve the overall integrity of health and human service programs
  • Conduct ongoing discovery by constantly maintaining and evaluating your beneficiary

Reduce Fraud through Public Records and Identity-driven Analytics

LexisNexis identity-driven analytics and public records solutions provide a powerful, simple way for government agencies to achieve significant fraud detection and avoidance. The unique information sources managed by LexisNexis provide an agency with a holistic view of identities, including non-banked or underbanked populations with no credit history and nationwide information that provides instant visibility across
state boundaries.

Request an Identity Solutions Demonstration

We have analyzed hundreds of millions of identities across dozens of federal, state and local systems for identity risk, and are the global leader
in mitigating identity risks. Learn how others have done it through an identity solutions demonstration today.

Get Your Demonstration!